Abords vasculaires pour hémodialyse

Hemodialysis treatments necessitate three times a week a double access to the blood circulation of the patients, allowing for flow-rates above 350 ml/min. Apart from end-stage renal disease, similar vascular accesses may be necessary for treatment of different chronic diseases, especially in children. Microsurgical creation of a direct arteriovenous fistula results in the enlargement of a superficial vein which becomes routinely easy to puncture. It is the best long-term angio-access. In contrast, the placement of prosthetic arteriovenous grafts frequently results in the development of early stenoses at the venous anastomosis that will lead to acute thrombosis. Central venous catheters placed through the internal jugular vein are very useful in case of urgent need for dialysis, but they are prone to infection and they frequently cause central vein stenosis or thrombosis; such procedure should be avoided therefore, as much as possible. Currently, duplex-ultrasound and interventional radiology play a major role in the creation and maintenance of hemodialysis vascular access.